PURPOSE: To determine whether a 32-gauge needle can reduce the pain associated with periocular injections of botulinum toxin type A compared with 30-gauge needles. METHODS: In this prospective, randomized, masked study, 30 patients received bilateral periocular injections of botulinum toxin type A for benign essential blepharospasm. For each patient, a 30-gauge needle was used on one side of the face, and a 32-gauge needle was used on the other side. Equal number of injections and equal amounts of botulinum toxin type A at each injection site were administered on each side of the face. Patients were then asked to rate their pain level on each side of the face, using a standardized 11-point visual analogue pain scale. RESULTS: The average pain score was 4.38 ± 2.02 for 30-gauge needles and 3.98 ± 1.65 for 32-gauge needles. Statistical analysis via Mann-Whitney U test confirmed the null hypothesis that no statistical difference in pain level existed between the 2 needle sizes. CONCLUSIONS: There is no difference in perceived pain when comparing periocular botulinum toxin type A injections with 30- and 32-gauge needles. In addition, smaller gauge needles require special order and result in greater cost. The authors recommend continued use of 30-gauge needles for botulinum toxin injection in the office setting.